Perlèche (overview) K13.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 18.12.2020

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Synonym(s)

angular cheilitis; Angulus infectiosus candidomyceticus; angulus infectiosus oris; Corner of the Mouthcheilitis; Corner of the mouth rhagades; Lazy Lick; Pearls; stomatitis angularis

Definition
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Polyätiological, acute or chronic, mostly rhagadiform inflammation of the corners of the mouth. Often with mycotic or bacterial infection at the base of an anatomical malposition.

Etiopathogenesis
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See Table 1.

Clinical features
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First described redness and scaling in the corner of the mouth, then rhagade formation. Formation of an oval, lenticular to pea-sized, erosive-crusty plaque. Particularly in older people the finding can be completely covered by the overhanging lips and only becomes visible when the lip sections are pulled apart.

Diagnosis
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Therapy
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Treatment of the underlying disease e.g.:

  • Lip involution: In case of senile lip involution with overlapping wrinkles in the area of the corners of the mouth and age-related turgor loss of the facial skin, consistent lip care with regular cleaning of the corners of the mouth (e.g. with dexpanthenol ointment).
  • Candidosis of the oral mucosa: consistent antimycotic therapy. S.u. Antimycotics.
  • Bacterial colonisation: Apply antibiotic-containing ointments, e.g. Fucidine ointment, several times a day to the corners of the mouth. Alternatively: application of disinfectant ointments or emulsions such as 0.5% Clioquinol-Externa(e.g. Linola-Sept, R049 ). In the case of a highly inflammatory overlay, the use of combination preparations ( glucocorticoid and antibiotic or antifungal) can be helpful in the short term (e.g. Decoderm tri cream, Candio-Hermal Plus paste, Lotricomb cream). Limit glucocorticoid combination preparations to 10 days' use.
  • For atopic cheilitis, use consistent lip care.

Tables
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Causes of perlèche

Infections

Candida species (so-called angulus infectiosus candidamyceticus, see also candidosis of the oral mucosa)

Streptococci, staphylococci (e.g. in impetigo contagiosa), often mixed flora

In case of unilateral perlèche V.a. syphilis (see below Syphilis acquisita)

Mechanical factors

Unhindered salivation in the absence of oral closure (elderly) or in age-related dermatochalasis with the upper and lower lateral parts of the lips lying on top of each other.

Hypersalivation (e.g. in mongolism)

Prognathism

In the context of lip eczema

As a manifestation of atopic eczema

Metabolic disorders

diabetes mellitus

Iron deficiency

Vitamin B12 deficiency (pernicious anemia)

Avitaminoses

Plummer-Vinson syndrome

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 18.12.2020